Ambulatory Care - The New Frontier of Quality & Safety

TeleTracking’s three-part Joint Commission webinar series, presented by Ann Scott Blouin, the Commission’s executive vice president, customer relations, wrapped up with the topic, “An Emerging Arena for Quality & Safety Issues: The Growth of Ambulatory Care”, featuring information from The Joint Commission’s perspective and experience, along with ambulatory industry knowledge.

Download the webinar recording and slide deck.

Geographically diverse. Different reporting structures. The topic of ambulatory care, and the quality and safety implications, is particularly relevant as more and more work is done outside the four walls of a traditional hospital. The Centers for Disease Control and Prevention (CDC) has reported that the number of visits to physician offices, hospital outpatient facilities and emergency departments totals 1.2 billion¹. Today, the Ambulatory Health Care program at The Joint Commission accredits over 2,100² organizations in a variety of settings.

 

Although the physical settings are changing, patients still expect communications to be seamless among providers and a safe, high quality experience to be delivered. From a cost perspective, there are shifting financial imperatives that also support a more integrated and efficient approach to care.   In keeping with these trends, more and more providers are collaborating with ambulatory providers as they manage patients who no longer require an acute hospital stay.

Let’s start by addressing potential quality challenges. It is the iterative, flexible nature of ambulatory care that can lead to safety and quality risks since many practitioners only see their patients episodically and then only for a brief time. These facilities also don’t always have the performance improvement resources of a large hospital. Some of the safety risks that have been analyzed in the ambulatory arena are related to lack of clinical data and communication across the continuum. Medication, diagnostic, and laboratory errors are also safety risks that have been publicly shared.   The Joint Commission continues to observe situations that are related to sterilization and high level disinfection, the off-label use of blood glucose monitors, medical emergency preparedness, and sufficient access to care and scheduling.

And then there’s the financial impact of these errors with the shift away from the traditional fee for service model. In fact by 2018, 90 percent of federal reimbursement will be linked in some manner to quality through alternative payment methods—so the errors mentioned previously come with some steep financial penalties.

We have learned of five principles to help guide ambulatory practice teams in their efforts to promote safe, high quality care—and avoid financial penalties. These are also designed to help ensure that transitions across the continuum of care are smooth—especially for individuals managing chronic diseases where this is especially critical.  The care transitions should be³:

• Person-centered: focused on the needs and goals of patients and their caregivers
• Collaborative: taking advantage of the skills and talents of all team members
• Structured: using clearly defined protocols and processes
• Iterative: adjusting tasks as care and goals evolve
• Flexible: acknowledging that every patient is unique

In addition to guidelines listed above, there are also some suggested guidelines for performance improvement efforts. It starts with⁴:

• Collecting data on ambulatory care harmful events
• Identifying early achievable goals (short term and long term)
• Engaging patients and families as equal members of ambulatory safety improvement teams
• Linking inpatient and outpatient safety initiatives
• And when feasible engage in ambulatory clinic networks capable of conducting research

For example, Penn Medicine’s Abramson Cancer Center was able to streamline patient flow and provide transparency across a patients continuum of care.  To learn more about Penn Medicine, click here to download their case study.

As ambulatory centers play an increasingly important role in the total health and wellness of patients, finding the right technology and process design to manage information and communications is one solution to the elimination of errors and towards the improvement of the overall patient care experience.

To learn more about the solutions that can help improve communications and streamline operations at your ambulatory center, click here to download our datasheet.

We also invite you to join us at Becker’s ASC 22nd Annual Meeting, October 22-24 in Chicago.  To meet with a TeleTracking representative to learn more about how our solutions can help to optimize your outpatient care areas, click here to schedule an appointment.

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¹_{Source: Selected patient and provider characteristics for ambulatory care visits to physician offices and hospital outpatient and emergency departments: United States, 2009-2010.}

²_{Source: http://www.jointcommission.org/accreditation/ahc_seeking_ambulatory_health_care.aspx}

³_{Source: Plews-Ogan ML, et al: Patient Safety in the Ambulatory Setting. Journal of Internal General Medicine. 2004; 19: 719-725.}

⁴_{Source: Wynia M, Classen D. “Improving Ambulatory Patient Safety,” JAMA, December 14, 2001, Vol. 306, No. 22, pp. 2504-2505.}